Deprescribing and Reducing Inappropriate Medications

Deprescribing is the planned and supervised process of reducing or stopping medicines that may no longer be of benefit or that may be causing harm, with the aim of improving outcomes. It is closely tied to the identification of potentially inappropriate medications (PIMs) — drugs whose risks are likely to outweigh their benefits for a given patient — and is a central strategy for addressing inappropriate polypharmacy.

Definition

Deprescribing is the process of withdrawing or reducing the dose of medications, supervised by a clinician, with the goal of managing polypharmacy and improving outcomes; potentially inappropriate medications are drugs for which the risk of harm is judged to outweigh the expected benefit in a given patient or population.

Scope

The topic covers the concept and rationale of deprescribing, the explicit criteria used to flag potentially inappropriate medications, and the general structure of a deprescribing process. It is a reference description of these concepts and is explicitly not advice to start, change, or stop any medication for an individual, which is a supervised clinical decision.

Key concepts

• Potentially inappropriate medication (PIM)
• Inappropriate polypharmacy
• Beers Criteria
• STOPP/START criteria
• Tapering and withdrawal
• Prescribing cascade
• Goals-of-care alignment

Key theories

Deprescribing process model

Scott and colleagues describe deprescribing as a structured sequence: reconcile all medications, identify those that could be targeted (because of harm, lack of benefit, or changed goals), prioritize for discontinuation, plan and implement a tapering or stopping schedule, and monitor for benefit, withdrawal effects, or the need to restart.

Mechanisms

Deprescribing typically follows a structured process: assembling a complete and reconciled medication list; identifying candidate medicines using explicit criteria (such as the Beers Criteria or STOPP/START) and patient-specific judgement; prioritizing which to reduce or stop in light of harm, diminished benefit, and the patient's goals; implementing a gradual taper where withdrawal effects or rebound are possible; and monitoring outcomes, including the possibility that a stopped drug needs to be reinstated. Explicit PIM criteria support the identification step by listing drugs and drug-disease combinations that are commonly inappropriate, especially in older adults.

Clinical relevance

Deprescribing addresses the harms associated with inappropriate polypharmacy, including adverse drug events, drug interactions, and treatment burden; feasibility studies suggest structured discontinuation can be carried out without consistent harm in selected older adults. This entry describes the concept and process and must not be used to start, alter, or stop any medication, which requires individualized clinical supervision.

Epidemiology

Potentially inappropriate medication use is common among older adults and rises with the number of medicines taken; inappropriate polypharmacy is associated in observational studies with adverse drug events, falls, hospitalization, and increased treatment burden, which is what motivates deprescribing as a strategy.

Evidence & guidelines

The field combines a consolidating conceptual literature (systematic definition work and process descriptions) with explicit appropriateness criteria maintained by professional bodies — notably the American Geriatrics Society Beers Criteria and the European STOPP/START criteria — which are periodically updated. Trial evidence on patient-important outcomes of deprescribing exists but is heterogeneous and condition-specific.

History

Concern about inappropriate prescribing in older adults was crystallized by the Beers Criteria, first published in the early 1990s and updated repeatedly. The explicit term 'deprescribing' and its framing as a structured, supervised process emerged in the 2000s and 2010s, supported by feasibility studies and by systematic work to standardize its definition.

Debates

How strong is the outcome evidence for deprescribing?

While reducing inappropriate medication use is intuitively beneficial and feasibility studies are reassuring, randomized evidence that deprescribing improves patient-important outcomes such as mortality, falls, or quality of life is heterogeneous and condition-specific, so the strength of benefit remains debated.

Key figures

• Ian Scott
• Emily Reeve
• Doron Garfinkel
• Denis O'Mahony

Seminal works

• scott-2015
• reeve-2015
• garfinkel-2010
• ags-beers-2023

Frequently asked questions

What is a potentially inappropriate medication?

It is a medicine whose risk of harm is judged to outweigh its likely benefit for a particular patient or population; explicit criteria such as the Beers Criteria and STOPP/START list common examples, especially for older adults.

Why is deprescribing usually done gradually?

Some medicines can cause withdrawal effects or rebound symptoms if stopped abruptly, so a planned, monitored taper is often used; deciding whether and how to deprescribe is a supervised clinical judgement and not something this reference entry can specify for an individual.